So much change

Having survived the annual chaos that is the Christmas period in primary care, is there any chance of me being able to sit back and relax? Not a chance! Firstly I've just moved in to a company flat and although I should be used to moving by now (eight addresses in six years) it's still a pain. Especially when you don't have internet access for a week and have the best part of 200 emails to read through.

But moving house was the easy part, compared to managing a new pharmacy which hasn't had a manager for a few months. So I've got stacks of paperwork to sort out and staff to get to know, as well as dispensing and checking. This pharmacy is very busy front of shop, and is doing c10,000 items a month. If the GPs were to switch to 28 day prescribing this would probably leap to 15,000 or more. I do have some help however in the shape of a shop manager who can take care of a lot of things for me. So although I've been thrown in at the deep end somewhat, with no management training or experience, I have got a bit of a lifejacket. Best of all, I am thoroughly enjoying it. I have a good set of staff, with all three dispensers working towards their NVQ 3s and the GPs actually phone me back within 15 minutes or so for non-urgent queries.

My long term plan for the pharmacy is to get one of the dispensers trained as a checking technician so that I can use my time speaking to patients and carrying out services. I'd also like to get the GPs to change to 28 day prescribing which will increase our workload (and income), but make it easier to manage stock levels. At present we run out of amlodipine 5mg, simvastatin 40mg, ramipril and so on because we haven't got the space to store the stock needed. I've had scripts recently for 500 oxytetracycline, 400 erythromycin and 504 metformin! I expect the GPs to be a bit resistant to this change, however there is a way of implementing it that will actually decrease their workload: repeat dispensing. This means if a GP decides a patient is stable on their medication at a review they can issue prescriptions there and then to cover the patient until their next review is due. This means no need to sign repeat prescriptions every month, so reducing the GP workload, and means that I can see which patients are due for their prescriptions and when, and actually plan my workload.

The is just one fly in the ointment at present: the local dentists. Although they are allowed to prescribe a wide range of drugs, I am sure dentists get very little training in therapeutics. I spoke to one of them recently about a prescription for metronidazole 400mg to be taken four times a day (it's normally three times a day and has a half life of around 8 hours). Neither the British National Formulary nor the Medicines Compendium mention four times a day dosing, and if it isn't mentioned in one of those sources it's a strange dose. So I spoke to the dentist about this, I was told to leave it a four times a day. When I asked if there was any particular reason why (like some really nasty infection that only dentists see and no one else knows about) I was told 'because that's how I want it.'
So I told the patient that their dentist wanted them to take this antibiotic four times a day, but added that it's always three times a day, and that's what I would do. I then wrote the dentist a lovely letter, asking for any evidence they had to support the use of metronidazole four times a day. Still waiting for a response...